*Work Setup: Hybrid (1–2 days on-site per week)
Key Responsibilities:**
Review and process standard or less complex insurance claims (electronic and written).
Respond to customer inquiries regarding claim status; document interactions accurately.
Validate claims by verifying policyholder details, effective dates, eligibility, and premium status.
Request updates or corrections from claimants as needed.
Research and obtain additional information from appropriate sources to complete claims.
Calculate payments, secure necessary approvals, and process disbursements.
Communicate claim resolutions and escalate concerns appropriately.
Required:
High school diploma or GED
2–3 years of relevant experience (claims processing, Medicaid/Medicare, or paralegal background)
Proficiency with Microsoft Office and ability to navigate multiple systems/web-based tools
Strong attention to detail and ability to analyze fine print and make sound decisions
Excellent data entry and written communication skills
Preferred:
Experience with insurance or medical terminology
Claims processing or customer service experience in healthcare or legal settings
Ability to handle confidential information with discretion
Strong multitasking and organizational skills
Hybrid role in an office environment with occasional on-site presence required.
Must be comfortable working independently and collaboratively within a team.
Claims Examiner • Irving, TX, US
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